Combination cancer immunotherapy "Expanding Paul Ehrlich's Magic Bullet Concept".

Please cite this article in press as: Elliott RL Oncology (2010), doi:10.1016/j.suronc.2010.0 The concept of cancer immunotherapy is not new and investigators have tried to stimulate the immune system tofight cancer for over a hundred years. However, success has been limited, inconsistent and very disappointing, thus preventing cancer immunotherapy frombecoming amainstreammodality of cancer therapy. In order to improve results of cancer immunotherapy, and catapult it into the mainstream of cancer treatment, an aggressive individual combined approach must be considered and attempted. This communication is admittedly an opinion commentary about a very complex subject and is not a review article. It is important that the reader appreciates this while contemplating the ideas presented. Paul Ehrlich's magic bullet theory has inspired many generations of scientist to explore numerous molecular cancer therapeutics. He connected chemistry to biology and medicine; and predicted the existence of specific cell receptors [1]. However, for cancer immunotherapy to be efficacious, it will take out of the box thinking, and applying a multiple magic bullet approach. Most cancer immunotherapy protocols and trials have only evaluated monocancer immunotherapy. Many of these studies have only been vaccine trials, and attempts to attack all arms of the immune system and escape mechanisms in the tumor microenvironment have not been explored at the same time. It is well known that cancer immunotherapy works better when there is less tumor burden, and that is and will be the role of cancer immunotherapy in the adjuvant setting. However, for Stage IV disease we must be